Why Eye Examination Important in Children?

Vision assessments are essential for the timely diagnosis of eye diseases that can be treated at an early age in children.

The first examination should be performed for diagnoses such as congenital cataracts, obstructions in the tear ducts, and congenital glaucoma within 1-2 months after birth.

At around one year of age, it is important to make some measurements of the baby's ability to follow with both eyes and whether there is a squint or not in terms of vision evaluation. Up to the age of 3, when the child can communicate with the doctor on a game basis, the first vision measurement can be made by teaching reading cards and pictures.

In terms of lazy eye (amblyopia), it is desirable to complete this examination up to 3 years of age. This examination should be repeated when begining school, even in children who have not had any problems later on. If there is a defect that requires glasses in the visual examination, the pupil is dilated and the measurement is made.

Most childhood eye diseases are treatable if diagnosed early. Since eye diseases that are not treated in childhood carry the risk of vision loss in the future; Children's eye exams should be paid attention to. Made works; shows that visual impairments affect one in twenty children entering school and one in four children attending school. For this reason, regular eye examinations are necessary for the early diagnosis of important problems. We can list the eye disorders seen in children as follows:

What Are Child Cataracts?

Although cataract is a very common problem in adults, it is a rare problem in newborns and childhood, but requires special care.

What is Cataract?

Cataract is when the naturally transparent lens becomes cloudy or ground glass and hinders vision development.

Cataract in Infants and Children - Congenital Cataracts

The type seen in the newborn period is called 'congenital cataract'.

Congenital cataracts may or may not be familial. It can affect one or both eyes. Generally, congenital cataracts can also be seen with other diseases related to the eye. It can be seen together with a systemic metabolic disease.

What is Tear Tract Obstruction in Babies?

The first few weeks after birth is a period in which rapid developments are experienced regarding the nervous system and visual pathways. Early diagnosis and timely surgery are important. During this period, if the eye and related brain areas do not receive enough stimulation for vision, normal visual function development cannot occur. This development cannot be achieved afterwards.

How Is It Treated?

In some babies, there may be duct obstruction due to the fact that a membrane that normally opens in the mouth of the nasal canal during birth does not disappear or that this canal does not develop well.

When there is a yellow-green inflamed burr, if the doctor deems it necessary, he may give antibiotic drops with massage. Probing is applied in blockages that do not open until one year of age, in the presence of uncontrollable continuous burrs, or in the presence of severe infection in the surrounding tissues. There is no incision in probing and there is no pain afterwards. However, since the procedure requires the baby to be immobile, it is performed under general anesthesia with a mask. Probing before 18 months increases the chance of success. Two procedures were performed, but in recurrent cases, tube placement is performed under general anesthesia. The tube is left for 4-5 months. It can then be removed without the need for anesthesia.

What is Retinopathy of Prematurity?

Retinopathy of prematurity (ROP) is a retinal disease seen in low birth weight preterm (premature) infants.

In ROP screening, the limit is generally accepted as less than 32 weeks and less than 1500 g. However, the pediatrician may determine the necessity of an ROP examination for a baby born in any week or kilogram. The development of retinal vessels is incomplete. When premature birth occurs, the development of these vessels may stop. When the veins try to grow back, abnormal vascularization may occur, especially when high-intensity oxygen is given. Regular retinal examination is performed to detect the presence of abnormal vascularity early in this way and to try to stop it if possible. The examination is performed in the hospital environment by dilating the pupils with eye drops. If ROP is detected, it is followed up at the necessary weekly intervals. Sometimes the vessels complete their enlargement and ROP regresses, sometimes it goes into advanced stage. When this transition period is detected, vision loss is tried to be prevented by laser applications to the retina or intraocular injections.

What is Lazy Eye? (Amblyopia)

It is the failure of the visual pathways to develop as a result of the eye's inability to see well due to reasons such as hyperopia, myopia, astigmatism, cataracts, and strabismus.

Often one eye is normal and the other eye is hyperopia, astigmatism or myopia. Low vision causes lazy eye. However, when there is high hyperopia, myopia, and astigmatism, bilateral laziness may also develop. Four out of every hundred children have lazy eye. If the cause of lazy eye is cataract or strabismus, the family may notice it. However, if one eye is normal and the other eye has a high degree of refractive error such as hyperopia, myopia and astigmatism, it is not possible for the family to notice. Because a child with normal vision in one eye has no complaints. For this reason, every parent should have their child's eyes checked before the age of 5. Eye disorders are often inherited. Children with a family history of eye disorders are at higher risk of laziness. In such cases, an eye examination may be required at an earlier age.

Strabismus

It is wrong to wait with the hope that the strabismus will heal on its own, the question 'I wonder if my child's eye is squinting' and many details behind this problem... Early diagnosis and treatment are important in the treatment of strabismus. Delay in treatment affects success and reduces the chance of success after a certain age, even making it impossible. For this reason, great duties fall between parents and physicians regarding strabismus. An abnormal finding, which attracts the attention of the family in children, should not be neglected when a symptom is detected, and it should not be distracted by the thought that 'it is a child and then it gets better'. It is very wrong to wait with the hope that the slip will correct itself.

What is Strabismus?

When the two eyes look at a distant object, it is called strabismus when the parallelism of their optical axes is disrupted. In the researches, strabismus, which is evident (manifest), was found in 2 percent of the population. 4 percent have three-dimensional visual defects that cannot be shown (not demonstrated). Laziness (ampliopia) is often reversible. However, if it is not diagnosed and treated in time, it cannot be treated in later ages. Strabismus is a cause of laziness and is a disease of particular importance in this respect. There are various forms of strabismus, including horizontal shifts (in-out) and vertical shifts (up-down). As it can be seen at any age, it can also be seen in childhood, and parents have a big responsibility in strabismus seen at this age.

Causes of Strabismus

Diseases and conditions associated with strabismus are: Problems during pregnancy (premature birth, intrauterine infections), birth trauma (forceps, vacuum), family history, congenital anomalies, mental retardation, chromosomal diseases, low health level and eye diseases. In most cases, strabismus may not be associated with neurological and eye diseases. In some cases, they cause laziness and squint. Diseases that cause squint; high refractive errors, drop lids (ptosis), developmental disorders of the eye and intraocular diseases.

Testing Vision in Young Children

We have said that parents have a great responsibility for strabismus, which is so common in society. What should parents suspect in case of squint eyes in children:

• Asymmetry of the eyes in the child's gaze position.
• People from the surrounding state this situation.
• Abnormal head position in the child, tilting the head to the side, inability to hold it upright.
• If the child has a vision problem, especially if he or she looks closely at the television, it can be suspected in terms of both refractive errors and strabismus.

Except for suspicion, when the child is born under normal conditions, he should be consulted with ophthalmologists at the age of 1, 3 years.

Strabismus Treatment Methods

In order to be able to treat strabismus, first of all, correct diagnosis is important. This goes through the mother-father and physician. Early diagnosis and treatment increase the chance of success in the treatment of strabismus, because the chance of treatment decreases with advancing age. The purpose of strabismus treatment;

• Correction of squint.
• Correction of ambliopi.
• It is the correction of binocular vision (three-dimensional vision with both eyes).

Correcting Squint

Correction of the squint is achieved by optical or surgical treatment.

Optical Treatment:

The most valid treatment method in accommodative strabismus with normal AC/A ratio is glasses. From the age of onset of strabismus, the child is constantly put on glasses. In cases with a high AC/A ratio, bifocal glasses (with separate diopters for distance and separate diopters for near) are given.

Surgical treatment:

Çoğunlukla akomodatif olmayan ve kısmi akomodatif şaşılıklarda uygulanır. Bu yöntemle göz dışındaki kasların çekme kuvvetleri azaltılır veya çoğaltılır.

Lazy eye (Ampliopia) Correction:

It is mostly applied in non-accommodative and partially accommodative strabismus. With this method, the pulling forces of the muscles outside the eye are reduced or increased.

Correction of Binocular Vision (Two-Eyed Three-Dimensional Vision):

The most difficult step in the treatment of strabismus is the correction of binocular vision. For this, squint and laziness must have been treated before. Binocular vision is tried to be developed with special tools and methods. Early diagnosis and treatment are important in the treatment of strabismus. As a result of being late in treatment, it affects success, and after a certain age, the chance of success decreases or even becomes impossible. For this reason, great duties fall on the parents-physician in this regard. An abnormal finding or symptom that attracts the attention of the family in children should not be neglected when a symptom is detected, and a distracting notion such as 'it is a child and then it gets better' should not be had. It is very wrong to wait with the hope that the squint will correct itself.

What is droopy eyelids (ptosis) in children?

Unfortunately, droopy eyelids, which prevent vision and cause amblyopia in children, can be neglected with the thought that it can be taken care of when the child grows up. In order to avoid such a situation, the level of droopy eyelids should be evaluated well during the examination and the eyelids covering the pupil should be repaired by operation. 

When should droopy eyelids be treated?

Relatives of the patients can usually suspect whether the eyelid is droopy or not. However, sometimes they may encounter misinformation as they go to other doctors instead of an ophthalmologist. How much eye health will be affected by this situation is closely related to the timing of the operation. When families suspect a droopy eyelid in their child, they should consult an ophthalmologist.

How Is A Droopy Eyelid Treated? 

Eyelid drooping (ptosis) operations take an average of 15-20 minutes. Here we apply two methods. First, if the muscle that lifts the eyelid is working enough, this muscle should be strengthened to make it work better. The second is the method where we help it to work again by attaching an artificial sling if the muscle that lifts the eyelid is not working. Very good follow-up after the operation is important for eye health.